| | | | |  | | By Ben Leonard and Chelsea Cirruzzo | Presented by the Coalition to Strengthen America’s Healthcare | | | | |  Some Democratic governors, including New York's Kathy Hochul, seek to secure Medicaid approvals from the Biden administration before President-elect Donald Trump takes office. | Susan Watts/Office of Governor Kathy Hochul | THE MEDICAID SCRAMBLE — States are racing to have their Medicaid requests approved before the Trump administration takes power. The new administration is expected to have a very different view of Medicaid than the Biden administration, and GOP lawmakers in Congress are eyeing major changes. Some states want waivers that will impact their states’ budgets, but others seek to allow Medicaid to pay for social services, a Biden administration innovation that links health to social well-being, POLITICO’s Rachel Bluth, Maya Kaufman, Kelly Hooper and Robert King report. For example, Hawaii and California want waivers to use federal money to help low-income people with rent, and Pennsylvania and Rhode Island want to use their Medicaid dollars to help with access to nutritious foods. Democratic-controlled states expect that whoever President-elect Donald Trump chooses to lead CMS will support less government spending. “There’s always the nagging concern,” said Judy Mohr Peterson, Hawaii’s Medicaid director, who was in Washington last week for a fall conference of Medicaid agency staffers. “Our governor is very anxious also to get this through.” CMS doesn’t discuss pending waiver requests. Among the states with pending requests: California: The state has five requests pending, including one meant to improve its mental health infrastructure outside of institutionalized settings that Gov. Gavin Newsom pushed for while in Washington last week. Another would explicitly protect the state’s reproductive health infrastructure from funding cuts by a hostile federal administration. New York: Gov. Kathy Hochul is working with CMS to approve a managed-care organization tax — a levy on some health plans used to draw down more federal dollars. The state’s goal is to secure billions of dollars in additional federal revenue for higher Medicaid reimbursement rates for hospitals and other health care providers. The concept is widely viewed as a temporary gimmick, given its reliance on an obscure loophole that CMS said it plans to close. Hawaii: The state wants a five-year extension for one of its Medicaid waivers, including new expansions of prerelease coverage for incarcerated people, nutrition support and “continuous coverage” for young children so they don’t fall off Medicaid rolls for bureaucratic reasons. WELCOME TO MONDAY PULSE. We wonder if RFK Jr. really ate the McDonald’s meal on Trump’s plane . Send your theories, tips, scoops and feedback to bleonard@politico.com and ccirruzzo@politico.com and follow along @_BenLeonard_ and @ChelseaCirruzzo.
| | | | A message from the Coalition to Strengthen America’s Healthcare: NEW REPORT: More than 60% of all Emergency Department visits occur after regular business hours or on weekends when other providers and care facilities are typically closed. Hospitals and health systems are indispensable, crucial access points for critical care 24 hours a day, 7 days a week, 365 days a year. ACCESS THE REPORT. | | | | | | | 
Faced with the possibility that Robert F. Kennedy Jr. could be the next HHS secretary, lobbyists are strategizing how to block or adapt to his anticorporate agenda. | Julia Demaree Nikhinson/AP | THE RFK JR. STRATEGY — Lobbyists anticipating a more typical pick to lead HHS than Robert F. Kennedy Jr. have a two-track strategy : plotting how to get the Senate to block Trump’s pick and currying favor if he’s confirmed, POLITICO’s Daniel Payne reports. Kennedy — who’s proposed additional regulation on pesticides, a reexamination of vaccine safety data, a ban on ultra-processed foods in schools and a revamp of health care and food agencies — could pose a major threat to American industry’s bottom line. More than a dozen lobbyists working for companies in Kennedy’s sights say they tell their clients to stay calm. Lobbyists who hadn’t taken the possibility seriously say their phones are blowing up over President-elect Donald Trump’s decision, and industry leaders are trying to quickly leverage any connections to Kennedy to mitigate the risk he could pose. Companies don’t want to start on the wrong foot with Kennedy by coming out “in an extremely adversarial posture,” said John Strom, special counsel at the law firm Foley and Lardner. “It’s prudent to take a wait-and-see approach,” he said, echoing lobbyists working across health and food sectors. Companies would prefer to let their allies in the Senate sideline Kennedy before they spend political capital to fight him. Lobbyists hope the White House will overrule any Kennedy plans that would threaten their employers. Brand-name drug lobby PhRMA responded to Trump’s pick with a statement that focused on how the pharmaceutical industry and the incoming administration could work together, ignoring Kennedy’s harsh criticisms of the industry.
| | ‘BEFUDDLING’: GROUP LOOKS IN THE MIRROR — The abortion-rights movement’s pitch that Donald Trump was too much of a threat to let back in the White House wasn’t enough. The movement’s leaders and candidates are grappling with how millions voted for ballot initiatives backing abortion rights but also voting for Trump and Republicans, POLITICO’s Alice Miranda Ollstein reports. Prominent movement members said they found it “befuddling,” “shocking” and “mind-boggling” that the abortion-rights message that helped Democrats hold off a red wave in 2022 and win key races in 2023 failed this year. The divide: Abortion-rights activists are dealing with disagreements in their ranks over how they need to move forward. Some blame Democrats and advocates for chasing the moderate white Republican vote at the expense of the party’s base, while others worry that ballot initiatives made people more comfortable voting for Republicans. Advocates and officials also fear that President-elect Trump and other Republicans largely succeeded in neutralizing Democratic attacks on their anti-abortion records by reinventing themselves as moderates. Some point to ballot initiative results mostly supporting abortion rights to show that it’s still a winning issue.
| | | | The lame duck session could reshape major policies before year's end. Get Inside Congress delivered daily to follow the final sprint of dealmaking on defense funding, AI regulation and disaster aid. Subscribe now. | | | | | | | TELEHEALTH: THE PATH FOR PBM REFORM? Given the low expectations for policymaking during Congress’ lame-duck session, a telehealth extension could be one of the most likely paths forward for pharmacy benefit manager reform. Popular eased rules for virtual care in Medicare expire at the end of the year, and Congress would be loath to let them run out, but it needs a way to pay for it. Agreeing on the details of PBM reform has proven vexing for lawmakers despite bipartisan support for the concept. Changes to the PBM’s business practices would likely be a cost-saver. The companies that negotiate drug prices have come under bipartisan fire, with critics accusing them of driving drug costs higher. The House Energy and Commerce and Ways and Means committees have overwhelmingly advanced telehealth bills with PBM changes, and lawmakers, including Rep. Buddy Carter (R-Ga.), told Pulse they’re eyeing telehealth reform as a way to get PBM legislation signed into law. The Ways and Means version adds reporting requirements for the pharmacy benefit managers, and the E&C version “delinks” payment to PBMs from drugs’ list price. The obstacles: Lawmakers still need to agree on the specifics of PBM reform and telehealth legislation. For example, the E&C version would pay federally qualified health centers and rural health clinics at parity between in-person and virtual care, while the Ways and Means version wouldn’t. They’ll also face fierce opposition from PBMs. “Policy proposals that hand Big Pharma a financial windfall, paid for by Medicare beneficiaries and taxpayers, should not be considered as a pay-for for any legislation,” said Greg Lopes, a spokesperson for PBM lobby PCMA. McCAUL OUT — Rep. Michael McCaul (R-Texas) won’t seek a waiver to get around term limits and remain in his position as chair of the House Foreign Affairs Committee. The move means there’ll be a wide-open race to chair the committee, which has significant power over global health issues. McCaul has been a proponent of PEPFAR, the global HIV-AIDS program whose authorization will expire in March and has been the subject of controversy in recent years despite enjoying decades of bipartisan support, with Republicans accusing the program of aiding abortion rights. McCaul has resisted calls from House Republicans to use military force against Mexican cartels over fentanyl. Who could replace him: Committee Vice Chair Ann Wagner (R-Mo.) and fellow committee members Joe Wilson (R-S.C.), Darrell Issa (R-Calif.) and Brian Mast (R-Fla.) are in the mix.
| | | | A message from the Coalition to Strengthen America’s Healthcare:   | | | | | OT RULE NIXED — A federal judge vacated the Biden administration’s significant expansion of overtime pay, ruling the Labor Department overstepped its authority, POLITICO’s Nick Niedzwiadek reports. DOL finalized a regulation this spring that mandated time-and-a-half pay for a broader class of workers when they surpassed 40 hours on the job in a given week. It applied to a substantial group of workers in health care, including nonclinical office staff and administrators. The decision likely kills the rule in its current form. The incoming Trump administration isn’t expected to defend it in court and could draft its own version as the first Trump administration did. DEA EXTENDS TELEHEALTH RULES — The Biden administration gave the incoming Trump administration a new task: grappling with the future of controlled substance prescribing via telehealth. The DEA said Friday that pandemic-era rules allowing many controlled substances to be prescribed without an in-person visit will continue through the end of 2025. The rules had been set to expire at the end of the year. The issue has vexed the Biden administration, which has been at odds over what to do about the future of telemedicine prescribing. A new administration will face the same competing interests: access to treatment and preventing misuse. HHS and the DEA had disagreed over a draft rule that would have dealt a significant blow to the telemedicine industry. POLITICO first reported in August that the DEA intended to impose substantial limits on providers’ ability to prescribe the substances virtually, including allowing no more than half a provider’s scripts to be given virtually. That drew backlash from the telehealth industry and many in Congress on both sides of the aisle.
| | | | Policy change is coming—be the pro who saw it first. Access POLITICO Pro’s Issue Analysis series on what the transition means for agriculture, defense, health care, tech, and more. Strengthen your strategy. | | | | | | | | POLITICO’s Carmen Paun reports that DEA Administrator Anne Milgram said Friday that illicit fentanyl is becoming weaker. POLITICO's David Cohen reports that Dr. Deborah Birx, Covid response coordinator in the first Trump administration, predicts that Robert F. Kennedy Jr.'s HHS nomination will spark public debates on public health. Modern Healthcare reports on a lawsuit against HHS' Inspector General to compel it to release Medicare Advantage audits.
| | | | A message from the Coalition to Strengthen America’s Healthcare: NEW REPORT: In 2021 alone, Americans visited Emergency Departments more than 83 million times after hours or on weekends when other providers and care facilities are typically closed. With more than 60% of ED visits occurring on weekends or after regular business hours, when many other providers are closed, hospitals play an essential role in their communities, providing crucial access points for care 24 hours a day, 7 days a week, 365 days a year to all patients.
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