A health care earthquake in Congress

Presented by the Coalition to Strengthen America’s Healthcare: Delivered daily by 10 a.m., Pulse examines the latest news in health care politics and policy.

Dec 19, 2024 View in browser   By Chelsea Cirruzzo and Ben Leonard Presented by the Coalition to Strengthen America’s Healthcare Driving The Day A comment posted on X by Elon Musk has sent Congress' stop-gap spending package into a tailspin. | Francis Chung/POLITICO HEALTH CARE UNCERTAINTY — After Congress spent years crafting new significant pharmacy benefit manager regulations and had agreed to a substantial health care package, posts on X from Elon Musk, who’s co-leading the so-called Department of Government Efficiency, helped upend the legislation just days before it was poised to become law. Welcome back to Donald Trump’s Washington. After offering no direction on how President-elect Donald Trump wanted Congress to operate in the lame-duck session, those in his orbit and eventually Trump weighed in Wednesday, derailing the stopgap spending package as the government is set to shut down Friday night. Trump and Vice President-elect JD Vance threw in a last-minute request for Congress to address the debt ceiling — something not on lawmakers’ radar to address until next year. “Republicans must GET SMART and TOUGH,” Trump and Vance said in a joint statement, adding that they need to avoid “DEMOCRAT GIVEAWAYS.” Republicans have expressed doubts about accomplishing Trump’s 11th-hour demands. Democrats argue the late move could lead to a government shutdown. The legislation drawing Trump’s ire contains the PBM provisions, a significant extension of eased telehealth rules and extensions of a host of expiring programs. Before Wednesday, the health package negotiated by Democrats and Republicans had been expected to become law despite objections from conservatives over its scope. The questions that remain: The impasse has left a multitude of health care provisions up in the air and the broader package’s fate in question. Eased access to telehealth and hospital-at-home care, funding for community health centers, doctor pay in Medicare, measures intended to incentivize drug development for rare pediatric diseases and more hang in the balance. “Everyone’s sparring a bit,” Senate Finance Chair Ron Wyden (D-Ore.) told Pulse Wednesday night. “Obviously, I want to get them now. … I’m going to be constructive with everybody.” If lawmakers move forward with a relatively clean continuing resolution to temporarily fund the government, it would be a major win for PBMs. The health care industry is mobilizing to convince lawmakers to continue expiring policies. Even with a “clean” CR, lawmakers would be expected to continue eased access to telehealth and extend other programs as they have in many previous CRs. “Congress must act now to avert the end-of-year telehealth cliff,” said Alye Mlinar, executive director of Telehealth Access for America. White House press secretary Karine Jean-Pierre called on Republicans to stop “playing politics.” “Triggering a damaging government shutdown would hurt families who are gathering to meet with their loved ones and endanger the basic services Americans from veterans to Social Security recipients rely on. A deal is a deal. Republicans should keep their word,” she said in a statement. WELCOME TO THURSDAY PULSE. Socialite Paris Hilton joined lawmakers on Capitol Hill this week to celebrate the passage of a bill to reform residential youth facilities. Hilton was sent at age 16 to a series of boarding schools for troubled teens where she says she experienced abuse. Send your tips, scoops and feedback to ccirruzzo@politico.com and bleonard@politico.com and follow along @ChelseaCirruzzo and @_BenLeonard_.   A message from the Coalition to Strengthen America’s Healthcare: NEW REPORT: Hospitals are there for rural Americans 24 hours a day, 7 days a week, 365 days a year providing crucial access to care. In rural America, where access to physicians for routine and preventative care is especially limited, Americans rely heavily on hospitals for their care. In 2021 alone, rural patients turned to hospital Emergency Departments 18 million times for immediate care. ACCESS THE REPORT.   AROUND THE AGENCIES The Countermeasures Injury Compensation Program has received more than 13,000 claims related to Covid-19 since the beginning of the pandemic. | John Locher/AP MASS COVID INJURY CLAIMS — A federal program that compensates patients and families of those injured or killed by medical countermeasures, like drugs or vaccines, received an unprecedented surge in claims in response to the Covid-19 pandemic — approximately 27 times more claims than all the claims submitted during the first decade of the program, created in 2009. According to a Government Accountability Office report released Wednesday, the Countermeasures Injury Compensation Program received 13,333 claims, which were related to the pandemic, compared with 491 claims in the program’s first 10 years. Why it matters: Many conservatives continue to rail against what they say were missteps in the Covid- response, with some casting doubt on the safety and efficacy of the vaccine after reports of myocarditis —inflammation in the heart — in some individuals. And Robert F. Kennedy Jr., President-elect Donald Trump’s pick to lead HHS, has criticized laws that protect vaccine manufacturers from liability lawsuits. As of June, 75 percent of claims were still pending, according to the report. Of the 25 percent of claims completed, 3 percent were eligible for compensation, and 56 percent were related to Covid. HHS has paid roughly $6.5 million in compensation, mostly going toward eligible claims for serious injuries caused by the H1N1 vaccine, and $400,000 for injuries, including myocarditis, related to Covid. According to the report, HHS officials said they had challenges processing the large number of claims due to staffing shortages, outdated information systems and limited scientific backing to base decisions on injuries related to Covid.   You read POLITICO for trusted reporting. Now follow every twist of the lame duck session with Inside Congress. We track the committee meetings, hallway conversations, and leadership signals that show where crucial year-end deals are heading. Subscribe now.     Health Costs HIGHEST HEALTH SPENDING SINCE 2020 — Health care spending jumped 7.5 percent last year — up from a 4.6 percent increase in 2022 — the highest numbers since the height of the Covid pandemic in 2020, according to new estimates, POLITICO’s Kelly Hooper reports. That leap comes as more people enrolled in health insurance and sought medical services, with the U.S. spending nearly $5 trillion on health care in 2023, according to CMS’ Office of the Actuary in a research article published Wednesday in Health Affairs. The findings: Spending in private health insurance and Medicare drove the increase in 2023, according to the analysis. The health sector’s share of the economy in 2023 was 17.6 percent, similar to its share of 17.4 percent in 2022. The insured share of the population grew from 92 percent in 2022 to 92.5 percent in 2023, contributing to the increase in spending, mostly because of rapid growth in enrollment in the Obamacare marketplace. Affordable Care Act enrollment has seen record numbers over the past few years, partly because of enhanced premium subsidies made available through the American Rescue Plan Act and extended through the Inflation Reduction Act. The subsidies, which were extended to middle- and upper-income people who weren’t previously eligible for help paying their premiums, are set to expire in 2025 unless Congress acts. People also spent more out-of-pocket in 2023, with total expenses growing 7.2 percent to about $506 billion. Key context: The findings are on track with reports from Medicare Advantage insurers since after the end of the Covid public health emergency.   A message from the Coalition to Strengthen America’s Healthcare:   BIRD FLU CA STATE OF EMERGENCY — California Gov. Gavin Newsom on Wednesday declared a state of emergency on avian flu, saying the outbreak among cattle in the state is “likely to be beyond the control … of any single local government and require[s] the combined forces of a mutual aid region or regions to appropriately respond.” Sixty-one human cases of bird flu have been reported across nine states; more than half of those cases are in California. And on Wednesday, the CDC confirmed the first severe human case of H5N1 bird flu in the country in a Louisiana patient who has been hospitalized. The emergency proclamation allows California to “provide state and local agencies with additional flexibility around staffing, contracting, and other rules to support California’s evolving response." Context: Bird flu has spread rapidly across the U.S., infecting mainly dairy cattle and commercial poultry flocks. Since 2022, when this virus outbreak began, more than 100 million birds have died, and since the beginning of 2024, hundreds of dairy herds have also been infected. Federal health officials said they don’t consider the virus endemic to the U.S. in either animals or humans.   POLITICO Pro's unique analysis combines exclusive transition intelligence and data visualization to help you understand not just what's changing, but why it matters for your organization. Explore how POLITICO Pro will make a difference for you.     Names in the News Julia Pursley is now director of industry relations at Harris Data Integrity Solutions. She was previously senior director of knowledge practice at the American Health Information Management Association.   A message from the Coalition to Strengthen America’s Healthcare: NEW REPORT: Rural patients turned to hospital Emergency Departments 18 million times in 2021 alone. Hospitals provide essential care in rural America, where access to physicians for routine and preventative care is limited, providing immediate, unscheduled care. ACCESS THE REPORT.   WHAT WE'RE READING The New York Times reports that measles is killing thousands of children in the Democratic Republic of Congo. The Washington Post reports on new research into a possible link between microplastics and cancers.   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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