The Biden administration fights to make its Covid funds last

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May 13, 2022 View in browser   By Sarah Owermohle and Krista Mahr Presented by Editor's Note: POLITICO Pulse is a free version of POLITICO Pro Health Care's morning newsletter, which is delivered to our subscribers each morning at 6 a.m. The POLITICO Pro platform combines the news you need with tools you can use to take action on the day's biggest stories. Act on the news with POLITICO Pro. QUICK FIX — Without new funding in sight, administration officials debate moves to make depleting cash last. — Warp Speed didn't plan for vaccine hesitancy and needed a communication strategy, says a former official. — Health officials promised a 60-day notice on ending the Covid emergency. That deadline springs up again Monday. WELCOME TO FRIDAY PULSE — We don't often cover dental care in Pulse, but this PBS NewsHour piece is worth a read. Send news and tips to sowermohle@politico.com and kmahr@politico.com.   A message from PhRMA: New data show that 35% of insured Americans spent more on out-of-pocket costs than they could afford in the past month. Read more about how insurance is leaving patients exposed to deepening inequities.   Driving the Day Biden officials warn that with a fall wave, they can't supply new vaccines or other tools on current funds. | AP Photo ARE NEW COVID FUNDS EVER COMING? Just two months after unveiling a nearly 100-page roadmap out of the pandemic, administration officials' doubts are growing about Congress' willingness to fund the nation's fight. With the prospect of a shoestring budget on the horizon, Biden officials are already debating deep cuts to their Covid operation and gaming out ways to keep the federal effort afloat on a month-by-month basis, reports our Adam Cancryn. On the table: Officials have discussed limiting access to the next generation of vaccines to only the highest-risk Americans — a rationing that would have been unthinkable just a year ago when the White House touted vaccine development and widespread availability and promises of vaccine research as the clearest way out of the pandemic. But as the government's cash reserves dwindle, officials increasingly conclude that those types of difficult choices will soon have to be made. And they're quietly preparing to shift responsibility for other key parts of the pandemic response to the private sector as early as 2023. Even the bare minimum rests on a cash refresh. Many of the decisions being discussed still hinge on Congress authorizing $10 billion in new spending, Adam writes. People familiar with the planning said should the Senate manage to break its impasse, the funding would still only be enough to keep the government's core Covid activities running. Nearly half that amount would immediately go toward paying the administration's debt to drug company Pfizer, which has yet to be fully compensated for supplying 20 million doses of its antiviral treatment earlier this year. "There's a great deal of concern that we're going to be caught shorthanded," said one person familiar with the discussions. "On the face of it, it's absurd." Gustave Perna talked with POLITICO about his tenure as COO of Operation Warp Speed during the Trump administration. | Getty Images PERNA REFLECTS ON THE VACCINE OUTREACH THAT WASN'T — Former Operation Warp Speed official Gustave Perna has laid low since retiring as an Army four-star general last summer. The chief operating officer for the Trump administration's record effort to launch coronavirus vaccines became a key figure in the early and sometimes bumpy rollout of millions of Pfizer and Moderna doses at a point when people were clamoring to get the vaccine. But that's changed. Perna spoke with Kathy Gilsinan for POLITICO Magazine about lagging vaccination rates and what Warp Speed should have done. "What I get frustrated on … Where was the long-term strategy for getting people ready to start taking the vaccine? The vaccine was going to come," Perna said. He was careful to emphasize that vaccination is a "personal choice" but vented: "Where was the responsibility to not let this get politicized?" The unspoken thread: Perna never mentions Trump in the interview, but it's hard to deny that the former president — who had accused health officials of political sabotage and touted unproven medical claims from the White House press room — looms large in discussions of vaccine hesitancy and stalled vaccination rates. More than 90 percent of Democrats report receiving at least one Covid-19 shot as of this month compared to 55 percent of Republicans, according to the latest Kaiser Family Foundation Vaccine Monitor. Just 31 percent of Republicans reported getting a booster dose as well, compared with 68 percent of Democrats. The retired general said he's not tracking the numbers closely anymore. "We knew that by March [2021], that there would be enough vaccine for anybody who wanted the vaccine. Pretty frickin' amazing," he told Kathy. "At that point, I was a little bit taken aback by how many people were not taking the vaccine." WHAT THE CDC LOSES IF THE PHE ENDS   —  As policymakers again debate whether to end the national public health emergency for Covid-19, the Centers for Disease Control and Prevention finds itself on the cusp of losing critical improvements made to its ability to collect data about the virus. Backstory: The pandemic quickly exposed that the agency's patchwork system of data-gathering wasn't enough. Part of the public health emergency allowed the CDC to request data from states and hospitals they wouldn't otherwise have access to. The agency has been talking about permanently expanding its data authority to institutionalize those and other improvements, but that hasn't happened yet. "There's an expectation of public health as this beautiful, constant source of information," Daniel Jernigan, the CDC's deputy director for public health science and surveillance, told POLITICO this week. If the PHE ends, "there are different levers that may change, and that will lead to less information," he said. What's at stake:  Covid lab testing. The CDC would stop receiving Covid-19 test lab results from state and local health departments. That reporting has been mandated under the CARES Act. Syndromic data. The CDC would lose access to state and local admissions data from emergency departments to track Covid-19 trends at a local level. Hospital capacity data. In early 2020, only about 60 percent of hospitals were voluntarily reporting capacity data on available beds and ventilators, personal protective equipment, Covid-19 cases and deaths to the CDC. After the Centers for Medicare and Medicaid Services made it mandatory, 100 percent of hospitals have been reporting it, the CDC says. That information is now used to inform the agency's Covid-19 Community Level Map, which advises Americans when and where to mask up. Last month, CMS proposed a rule that would require hospitals to continue that reporting after the PHE ends until 2024. It hasn't been finalized yet. Nursing home data. Similarly, only a few thousand nursing homes were voluntarily reporting their PPE, Covid case numbers, deaths and resident and staff vaccination status to the CDC before CMS imposed a rule requiring them to do so. Now all nursing homes are reporting, according to the agency, but the CMS requirement will continue only under the current rule until 2024.     A message from PhRMA:   In Congress DEMS TURN TO MIDTERMS WITH FEW ROE OPTIONS LEFT — Democrats are facing up to their grim reality: After Roe v. Wade likely falls next month, they'll need a comeback November win to save it, write POLITICO's Sarah Ferris and Marianne LeVine. They have virtually no legislative power to prevent the Supreme Court from striking down five decades of abortion-rights precedent, especially with such narrow majorities. So, outraged lawmakers are instead taking the fight to voters — many of whom are pleading for a more immediate solution as the high court prepares to rule in June. Wednesday's failed vote on the Women's Health Protection Act was a bitter reminder that Democrats don't even have 50 votes for their signature abortion-access bill, let alone the 60 needed to bust a filibuster. That leaves Democrats imploring their constituents toward a midterm election that was already tilting away from the party. Until then, the party acknowledges its hands are tied, despite its control of Congress and the White House. "It'll go to the midterms. I can't see another way," House Judiciary Chair Jerry Nadler (D-N.Y.) said, even as he added that Americans "have to put pressure on the Senate."   DON'T MISS DIGITAL FUTURE DAILY - OUR TECHNOLOGY NEWSLETTER, RE-IMAGINED:  Technology is always evolving, and our new tech-obsessed newsletter is too! Digital Future Daily unlocks the most important stories determining the future of technology, from Washington to Silicon Valley and innovation power centers around the world. Readers get an in-depth look at how the next wave of tech will reshape civic and political life, including activism, fundraising, lobbying and legislating. Go inside the minds of the biggest tech players, policymakers and regulators to learn how their decisions affect our lives. Don't miss out, subscribe today.     Around the Nation HOW ROE's REVERSAL COULD REVERBERATE FOR RURAL CLINICS — In a one-story clinic with peeling white paint, San Marcos, Texas' Community Health Services provides health care, including family planning, to low-income, mostly Latina, women. This clinic, which is federally funded, doesn't perform abortions. It does dispense birth control pills, IUDs, implants, rings and other contraceptives to women who don't want a child or don't want a child right now. And its fate is in doubt, write Joanne Kenen and Alice Miranda Ollstein in POLITICO Magazine. Judy Gros, a nurse practitioner, has run the San Marcos clinic for 12 years and is set to retire but has found no successor, right at a time when contraceptive access could matter most. The struggles facing Gros' clinic and family-planning efforts reflect a series of broader trends. A nationwide nursing shortage has long existed, but it's been exacerbated by pandemic burnout, Republican-led efforts to limit family-planning care and, some advocates say, Democrats' failure to promote and protect access to contraception.   STEP INSIDE THE WEST WING: What's really happening in West Wing offices? Find out who's up, who's down, and who really has the president's ear in our West Wing Playbook newsletter, the insider's guide to the Biden White House and Cabinet. For buzzy nuggets and details that you won't find anywhere else, subscribe today.     What We're Reading It's hard to say whether the in-demand Covid-19 antiviral, Pfizer's Paxlovid, is reaching vulnerable patients most in need, Kaiser Health News' Hannah Recht reports. By the fall, "we are all going to have a lot more vulnerability to a virus that has a lot more immune escape than even it does today," White House Covid-19 response coordinator Ashish Jha told AP News' Zeke Miller in an interview where he stressed funding needs. Meat industry giants hyped "baseless" claims of meat shortages to keep plants running early in the pandemic, resulting in at least 269 worker deaths, according to a congressional panel's report covered by The Washington Post's Taylor Telford.   A message from PhRMA: According to data just released, insurance isn't working for too many patients. Despite paying premiums each month, Americans continue to face insurmountable affordability and access issues: Roughly half (49%) of insured patients who take prescription medicines report facing insurance barriers like prior authorization and "fail first" when trying to access their medicines. More than a third (35%) of insured Americans report spending more in out-of-pocket costs in the last 30 days than they could afford. Americans need better coverage that puts patients first. Read more in PhRMA's latest Patient Experience Survey.     Follow us on Twitter Tucker Doherty @tucker_doherty Dan Goldberg @dancgoldberg Erin Banco @ErinBanco Katherine Ellen Foley @katherineefoley Lauren Gardner @Gardner_LM Ben Leonard @_BenLeonard_ Rachael Levy @rachael_levy David Lim @davidalim Krista Mahr @kristamahr Megan Messerly @meganmesserly Alice Miranda Ollstein @aliceollstein Sarah Owermohle @owermohle Carmen Paun @carmenpaun Megan R. Wilson @misswilson   Follow us

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