Seeing double: Dueling transition teams ahead?

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Nov 04, 2024 View in browser   By Ben Leonard and Chelsea Cirruzzo Driving The Day Federal agencies like HHS could face having to brief two transition teams if neither presidential candidate concedes the election. | Alastair Pike/AFP via Getty Images GEARING UP FOR DOUBLE TROUBLE — If neither former President Donald Trump nor Vice President Kamala Harris has conceded Tuesday’s election by Nov. 11, both transitions could begin simultaneously. That would be extra work for federal agencies, which would need to navigate tricky relationships and double the briefings, POLITICO’s Sophie Gardner reports. Gail Lovelace, a former personnel chief at the General Services Administration who led transition preparations from 2007 to 2009, expects that agencies are prepared for that possibility. “They’re ready,” said Lovelace. “Now, is it more work? Oh, yeah.” The background: Congress passed a law in 2022 mandating that transitions begin five days after the election — even if the winner is still unclear. The change came after Trump refused to concede the 2020 election and delayed the incoming Biden administration’s transition for nearly three weeks. Extra work: Briefing both transitions would come with its own set of challenges for agencies like HHS, CMS and the FDA, for instance. They would need to set aside twice as much office space, give twice the briefings, and accommodate twice the requests from candidates’ transition teams. Agencies have “identified independent space to host transition teams for both candidates if there is not a concession within five days of the election,” White House spokesperson Saloni Sharma told POLITICO in a statement. A former member of an agency review team for the Biden-Harris 2020 transition — who was granted anonymity because they weren’t authorized in their current role to speak publicly on the subject — said this could be challenging for agency officials because the Trump and Harris teams might have different requests. Agency officials also would have to provide two teams with sensitive information, and the FBI would need to vet twice the number of people for security clearances. “It’s a huge amount of additional work,” said Max Stier, president and CEO of the Partnership for Public Service, a nonpartisan, nongovernmental organization that aims to make the government more efficient. Even so: The process would become even more complex if Trump refuses to enter into key agreements with the White House and the Government Service Association, the agency in charge of federal facilities, as Trump is considering. Those agreements allow his team access to the materials, agencies and security clearances needed to begin the transition. No previous president-elect has refused to sign those agreements, but declining to do so would allow Trump to raise unlimited funds without disclosing donors while avoiding oversight from federal bureaucrats, whom Trump and his advisers deeply distrust, POLITICO’s Hailey Fuchs and Meridith McGraw reported. WELCOME TO MONDAY PULSE. Hope for Duke football is a dangerous thing. Send your tips, scoops and feedback to bleonard@politico.com and ccirruzzo@politico.com and follow along @_BenLeonard_ and @ChelseaCirruzzo. CAMPAIGN 2024 The PAC, 314 Action, is spending millions to replace House Republicans like Arizona Rep. David Schweikert, above, with Democratic doctors. | Mark Schiefelbein/AP THE GROUP TRYING TO ELECT DEM DOCTORS — A hybrid Democratic PAC has poured millions into key House races this election cycle in a bid to double the number of doctors supporting abortion rights in Congress and give Democrats control of the House. 314 Action, which had its first full election cycle in 2018, is trying to elect scientists and physicians to pick up seats for Democrats in districts held by Republicans. That includes Amish Shah, a Democrat and emergency doctor running against Rep. David Schweikert (R-Ariz.) in a district that includes Phoenix suburbs. The group has raised and spent more than $70 million since its founding and about $3 million on advertising this cycle to elect doctors and nearly $6 million for all STEM candidates. The group has taken credit for helping elect lawmakers like Rep. Kim Schrier (D-Wash.), the first pediatrician in Congress, and Sen. Mark Kelly (D-Ariz.), an astronaut. This cycle, it has also backed doctors in primaries, including Maxine Dexter, who won a crowded Democratic primary to replace Rep. Earl Blumenauer (D-Ore.) and is expected to win the seat. “What we have seen in our research is that physicians do come with a lot of credibility as a candidate because of the trust that they’ve established as physicians,” Shaughnessy Naughton, the group’s founder and a former Democratic House candidate in Pennsylvania in 2016 and 2014, told Pulse. Research on Americans who voted for former President Donald Trump in 2016 and President Joe Biden in 2020 has shown that those voters — expected to be key in the races — have high levels of trust in science and expertise, Naughton said. That’s despite an overall decline in trust in public health experts since the pandemic. Rep. Suzan DelBene (D-Wash.), who chairs the Democratic Congressional Campaign Committee, said in a release that it’s “critically important to have data-driven scientists” in Congress, especially to “stand up to false attacks from science deniers.” RFK JR. TAKES ON FLUORIDE —  Robert F. Kennedy Jr., who former President Donald Trump has embraced, said Saturday that a Trump administration on Day One would “advise all U.S. water systems to remove fluoride from public water.” Kennedy claimed that fluoride is “industrial waste” tied to a host of medical conditions, including bone fractures and thyroid disease. Trump said in an interview with NBC News on Sunday that Kennedy’s proposal “sounds OK” to him and is “possible.” The Trump campaign didn’t confirm or deny Kennedy’s claim about the next potential administration’s fluoride plans in a statement to POLITICO, saying the former president is “focused on Tuesday’s election.” The CDC and other agencies don’t require water fluoridation, but most Americans get fluoridated water. The U.S. Public Health Service has recommended a level of fluorination in water. The CDC has pointed to studies showing that fluoridated water strengthens teeth and reduces cavities and has called fluoridation of drinking water one of the top 10 public health interventions of the 20th century due to a “dramatic decline” in cavities. The American Dental Association, the American Medical Organization and other leading health care groups have supported fluoridation. On that HHS secretary job: “I am confident that if I wanted to do HHS secretary, the president would fight like hell to make that happen, ” Kennedy said Sunday on Fox. AROUND THE AGENCIES DÉJÀ VU: CMS CUTS DOC PAY — CMS has finalized a 2.83 percent cut to Medicare payments for doctors taking effect in 2025, as lawmakers make a desperate push to stave off the latest decrease, Robert reports. Lawmakers on both sides of the aisle have lamented the state of doctor pay, a formula that hasn’t been updated since 2015. Doctor groups say the current formula doesn’t keep pace with the rising cost of running a practice. The American Medical Association, the Medical Group Management Association, the Primary Care Collaborative and other groups called on Congress to take action. The Hill has stepped in before to offer relief to doctors before cuts have taken effect. Rep. Greg Murphy (R-N.C.), a urologist, introduced bipartisan legislation last week that would eliminate the cut and would provide a small inflation update. However, a long-term solution remains elusive due partly to the price tag. WHAT ELSE WAS IN THE FEE SCHEDULE — CMS finalized a slew of other changes to payment policy in its 3,088-page final rule and a separate rule on home health payment. Here are some changes that stood out: Digital therapeutics: The agency finalized a proposal that will allow payment for FDA-cleared software-based treatments for mental health known as digital therapeutics. Insurers and psychiatric organizations had raised concerns about insufficient evidence to determine the technology’s efficacy, while digital therapeutics groups applauded the initial proposal. Telehealth: Telehealth advocates secured several wins in the final fee schedule, including rules temporarily allowing telehealth providers to report their in-person care locations, even if they provide care from their home and permitting audio-only virtual care permanently. But only Congress has the power to extend most of the eased pandemic-era rules surrounding virtual care. Some telehealth lobbying groups have warned of a potential gap in coverage if Congress waits until the 11th hour to do so — as it typically does. Home health: CMS will give home health agencies a 0.5 percent aggregate boost in Medicare payment for next year, the agency said in its home health final rule, after proposing a 1.7 percent aggregate cut. LeadingAge, which represents nonprofit long-term care facilities, said that data must be put into context in light of other factors. “This brings us to a nearly 9% permanent cut to home health payment since 2023,” the group’s CEO, Katie Smith Sloan, said in a statement. Names in the News Samantha Segall is joining Shift5 as vice president and head of government affairs. She was previously at Datavant. Layne Litsinger is now vice president of health media at MSL Group. She was previously senior account supervisor. WHAT WE'RE READING STAT reports that legal action aimed at fighting bias in pulse oximeters has begun to create change. POLITICO's Emily Ngo reports that a transgender issue has muddied the battle over a New York ballot measure.   Follow us on Twitter Dan Goldberg @dancgoldberg Chelsea Cirruzzo @chelseacirruzzo Lauren Gardner @Gardner_LM Sophie Gardner @sophie_gardnerj Kelly Hooper @kelhoops Robert King @rking_19 Ben Leonard @_BenLeonard_ David Lim @davidalim Megan Messerly @meganmesserly Alice Miranda Ollstein @aliceollstein Carmen Paun @carmenpaun Daniel Payne @_daniel_payne Ruth Reader @RuthReader Erin Schumaker @erinlschumaker   Follow us

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