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| By Daniel Payne and Krista Mahr |
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With Alice Miranda Ollstein
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 House Speaker Kevin McCarthy wants to raise the debt ceiling but at the expense of Covid-19 relief funds and Medicaid policy. | Francis Chung/POLITICO |
WORK REQUIREMENTS AND CASH RECALLS — The GOP plan for raising the debt ceiling is here — with goals of adding work requirements for Medicaid and clawing back unspent Covid funds, POLITICO’s David Lim reports. The proposed health provisions of the bill, unveiled Wednesday by House Speaker Kevin McCarthy, would require Medicaid recipients to work 80 hours a month and rescind Covid-19 relief funds that haven’t been spent or were obligated to be spent. Reality check: McCarthy’s health provisions in the plan — seen by some as a statement of values for the GOP — face stiff opposition from President Joe Biden and congressional Democrats. The overall proposal would raise the debt ceiling by $1.5 trillion and cut $130 billion from the federal budget in the next fiscal year. The cost savings from the health provisions weren’t detailed. Dems react: Biden slammed the plan as a nonstarter in a speech Wednesday, but McCarthy said he wants to pass the package next week. The work requirement has drawn criticism not only because of fears that Medicaid unwinding will leave many uninsured but also because of earlier policies that required employment for insurance. When Medicaid work requirements were added in Arkansas in 2018, more than 18,000 low-income adults lost health insurance, but employment didn’t appear to improve. House Energy and Commerce Committee ranking member Frank Pallone (D-N.J.) slammed the plan as dead on arrival, adding that Medicaid is critical for many people working part-time jobs that don’t offer health insurance as a benefit and the vast majority of those on Medicaid already have jobs. “Speaker McCarthy’s proposal is not about jobs,” Pallone said. “It is a Trojan horse intended to use red tape and onerous paperwork to kick millions of people off their health insurance because Republicans do not believe in our nation’s social safety net.” WELCOME TO THURSDAY PULSE, where we’re disappointed that, despite being on the Hill yesterday, we did not run into Elton John (who was advocating for PEPFAR funding). Are you Elton John? Or do you have a good health news tip? Drop us a line at dpayne@politico.com and kmahr@politico.com. TODAY ON OUR PULSE CHECK PODCAST, host Ruth Reader talks with Katherine Ellen Foley, who breaks down the FDA's new, simplified Covid vaccination regimen, including what it means for people who have never been vaccinated, have a compromised immune system or are over age 65.
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| A message from PhRMA: Putting profits before patients. Did you know that the 3 largest PBMs denied coverage to more than 1,150 medicines last year? That includes medicines that could lower your costs at the pharmacy. Patients need to see what’s going on. |
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The anti-abortion group Students for Life says the FDA failed to assess whether trace amounts of mifepristone in wastewater pose threats to the environment. | AFP/Getty |
A NEW LINE OF ATTACK — The influential anti-abortion group Students for Life launched the next phase of its campaign Wednesday to use the nation’s environmental laws to restrict the ability to terminate a pregnancy. In a citizen petition to the FDA — first shared with Alice — the group asked that access to the widely used abortion drug mifepristone be prohibited until the agency studies whether trace amounts of the pill in wastewater pose any risk to “endangered or threatened species or designated critical habitats.” The petition comes as access to the pills is already under threat. While Supreme Court Justice Samuel Alito ruled Wednesday to punt until Friday a decision on a lower court order that would severely curb access to mifepristone — the drug used in most abortions nationwide — the court could allow the restrictions to take hold in the coming days. The earlier order by the U.S. 5th Circuit Court of Appeals would roll back policies the FDA approved in 2016 to make the pill more accessible — including telemedicine prescriptions, mail delivery and retail pharmacy dispensing — and reduce the time patients can take the drug from 10 to seven weeks of gestation — before many know they’re pregnant. DRUGMAKERS SUE FOR ABORTION ACCESS — The maker of the generic version of a common abortion pill sued the FDA on Wednesday in an attempt to keep the drugs accessible, Alice reports. The company, GenBioPro, hopes the suit will bar the agency from rolling back access to the drug if sweeping restrictions from the 5th Circuit Court of Appeals take effect this week. The challenge, filed in federal court in Maryland where the agency is headquartered, argues that if the FDA implements a court order suspending approval of the drug, mifepristone, it would be “depriving GenBioPro of its constitutional and statutory rights to market mifepristone without affording GenBioPro due process of law.” A ruling by the 5th Circuit Court of Appeals now pending before the Supreme Court would unwind policies the FDA has approved since 2016 to make the abortion pill more accessible — including telemedicine prescriptions, mail delivery and retail pharmacy dispensing — and shrink the window of time patients are approved by the FDA to take the drug from 10 weeks to seven weeks of gestation — before many know they're pregnant.
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| A message from PhRMA:   |
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AN NIH NOMINATION — Monica Bertagnolli is expected to be the White House’s nominee to run the National Institutes of Health, POLITICO’s Adam Cancryn reports. The decision would end a lengthy vacancy atop the health research agency and vault Bertagnolli, a Boston cancer surgeon, into a top role just months after being appointed as director of the government’s National Cancer Institute. She became the first woman to occupy the job when she took over the role in October. The White House did not immediately respond to a request for comment. The Wall Street Journal first reported Bertagnolli’s expected nomination. If confirmed by the Senate, Bertagnolli would take control of a sprawling agency, which has traditionally enjoyed bipartisan support and is charged with investigating a range of diseases and finding new treatments. But the role could also put her in the middle of the fight over the origins of the coronavirus pandemic, a subject bitterly debated by parties and nations alike.
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| GO INSIDE THE 2023 MILKEN INSTITUTE GLOBAL CONFERENCE: POLITICO is proud to partner with the Milken Institute to produce a special edition "Global Insider" newsletter featuring exclusive coverage, insider nuggets and unparalleled insights from the 2023 Global Conference, which will convene leaders in health, finance, politics, philanthropy and entertainment from April 30-May 3. This year’s theme, Advancing a Thriving World, will challenge and inspire attendees to lean into building an optimistic coalition capable of tackling the issues and inequities we collectively face. Don’t miss a thing — subscribe today for a front row seat. |
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FULL SPEED AHEAD — The Energy and Commerce Health Subcommittee plans to move ahead with its agenda for transparency and compliance for health care, POLITICO’s Megan R. Wilson reports. The subcommittee will discuss more than a dozen proposals next week, and CMS Administrator Chiquita Brooks-LaSure will appear before the group. Most proposals on the April 26 hearing agenda fall under her agency’s jurisdiction, including a bill introduced by House E&C Chair Cathy McMorris Rodgers (R-Wash.) and ranking member Frank Pallone (D-N.J.) on Tuesday that would increase enforcement and penalties for noncompliance of hospital and insurer price-transparency rules.
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FIVE MORE YEARS — Senate Foreign Relations Committee leaders said they support a “clean reauthorization” of the President’s Emergency Plan for AIDS Relief for the next five years, POLITICO’s Carmen Paun reports. Sens. Jim Risch (R-Idaho), the top Republican on the committee, and Cory Booker (D-N.J.), the chair of the Africa and Global Health Policy Subcommittee, said at a hearing Wednesday that they want to keep the program going without policy changes bogging down the process. The focus instead should be on “rigorous oversight, including close scrutiny of PEPFAR’s local implementing partners,” Risch said.
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WHITE HOUSE WINS ON VAX MANDATE — On Wednesday, the 9th Circuit Court of Appeals sided with the Biden administration in a fight over its vaccination requirement for federal contractors, POLITICO’s Nick Niedzwiadek and Olivia Olander report. “President Biden was justified in concluding that requiring federal contractors who worked on or in connection with federal government projects to be vaccinated against COVID-19 would promote economy and efficiency,” Circuit Judge Mark J. Bennett wrote in the opinion reversing the lower court’s injunction. One reason the court sided with Biden: He made the policy through presidential action, not via an agency. “[W]e find that the Major Questions Doctrine is not relevant here because the Contractor Mandate is a Presidential — not an agency — action,” the opinion said, referring to the doctrine that limits the power of agencies to unilaterally make major decisions.
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VULNERABLE FOR YEARS — The Congressional data in the DC Health Link breach discovered last month was potentially vulnerable since 2018, POLITICO’s Maggie Miller reports. Personal data of members of Congress and hundreds of House staffers and dependents may have been exposed and vulnerable to theft for years, according to a top executive from the company in charge of the DC Health Link insurance market. The executive told members of the House Administration and Oversight Committees during a joint hearing on the breach Wednesday that, while an investigation is still ongoing, the “misconfigured server” involved in the breach was operating since 2018.
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WHAT HOSPITALS WANT YOU TO READ — A report out this morning from the American Hospital Association found that cumulative hospital expenses have grown 17.5 percent from 2019 to 2022. That increase has largely come from a 20-percent jump in labor costs, the hospitals say. The report compares the growth in costs to the slower growth of Medicare’s inpatient prospective payment system, a point hospital leaders will likely keep making to Congress and the administration.
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| A message from PhRMA: Insurers and their PBMs don’t want you to see that you could be paying more than they are for your medicines. Rebates and discounts can significantly lower what insurers and PBMs pay for medicines. These savings can reduce the cost of some brand medicines by 50% or more. But insurers and PBMs aren’t required to share those savings with you at the pharmacy counter.
They don’t want you to see that they use deductibles, coinsurance and other tactics to shift more costs on to you. Or that the three largest PBMs control 80% of the prescription drug market. Or that last year they blocked access to more than 1,150 medicines, including medicines that could have lowered costs for you at the pharmacy.
PBMs and insurance practices are shrouded in secrecy, they need to be held accountable. |
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Seema Verma, the former CMS administrator for the Trump administration, is expected to join Oracle. Donna Shalala, the former HHS secretary and Florida House Democrat, is joining the board of directors for Chapter, a Medicare navigation platform. Andrea Linna is now a partner in the regulatory department of Wilson Sonsini Goodrich & Rosati.
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The Wall Street Journal reports the nurse shortage is pushing hospitals to the gig economy. STAT reports that Mindpath has been on a journey from a success story of private equity in mental health to a cautionary tale.
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| 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. |
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